Can I run a marathon with a metatarsal stress fracture?

Hello Running Doc,

I have been training for my first marathon for the last four months. I have been following an online training plan and my mileage has been increasing steadily. After overcoming all of the initial soreness with the periods of increased distance, I have been doing well. Until recently…

I started having this aching pain in the ball of my foot. At first it was only when I was running. I iced it and kept training. Eventually I started having aching pain and throbbing on the top of my foot as well. I went to see my primary care doctor and I was told that I have a metatarsal stress fracture. My doctor told me I had to stop running for 6 weeks and skip the marathon.

Is it possible for me to still run the marathon, even though I have a metatarsal stress fracture?

Thanks for any advice!
Erin M.
Oakland, CA

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Metatarsal stress fractures are one of the most common causes of pain in the ball of the foot in runners. It is also one of the most common reasons that a marathon runner is forced to stop training and skip a race like a marathon.

The short answer is, yes, you could probably still run the marathon. However, that depends on several factors.

The doctor’s job is not to tell whether or not you can run. The actual job of the of a sports medicine podiatrist is to explain all the risks and benefits of a given course of action. It is then of course up to you to decide what is best for you given your circumstances.

Metatarsal stress fractures come in a full range of trouble. In the very early stages it is actually a stress response, that is affecting the metatarsal bone and causing the pain. In many cases of the stress response the metatarsal calms down and heals quickly. If you did not remove the stress that is being applied to the metatarsal (i.e. training) then the metatarsal stress response can get worse and a tiny little crack forms and the bone. This is a metatarsal stress fracture.

If you have a metatarsal stress fracture and you continue to ramp up your training it is possible that the tiny little crack can form a complete break in the bone. This is when the real trouble begins.

The first thing for you determine is whether or not you actually have a true metatarsal stress fracture or just a metatarsal stress response. If it is only a metatarsal stress response, you could substitute running for some other activities that apply less stressed to the metatarsal, maintain your fitness and then resume your training in time to run the marathon.

But if you have a true metatarsal stress fracture and you're not careful about which activities you choose, it is possible that the metatarsal stress fracture could turn into a completely broken bone that requires surgery for repair.

It is indeed possible that you could continue to train, with the appropriate direction, and then run your race. However, it is a dangerous game to play if you're not certain about the exact condition that is causing the pain in the ball of your foot.

You must work with a sports medicine podiatrist who specializes in the treatment of runners to guide you through the alternative activities so you can maintain your running fitness while decreasing the risk of making the stress fracture worse.


Dr. Christopher Segler is a runner,  sports medicine podiatrist and 14-time Ironman triathlon finisher. His practice focuses on the rapid treatment of running injuries, and a rapid return to running for his patients in the San Francisco, Oakland, and San Jose. He also does remote consultations via Skype for runners and triathletes overseas. If you have a question about metatarsal stress fracture that it is affecting your ability to run, you can reach him directly at 415–308-0833. You can also learn more about metatarsal stress fracture surgery for runners at DocOnTheRun.com and learn more about metatarsal stress fractures at AnkleCenter.com 


All content copyright 2015, Dr. Christopher Segler, Doc On The Run.

What is a Real Runner?

A couple of days ago I had an interesting conversation with a woman. We were talking about exercise, not just for fitness sake, but for enjoyment. About fitness as a lifestyle worth living. I asked her how much she runs, and she explained that she “only runs a few miles several days per week.”

“You seem like a real runner,” she said.

I remember feeling an involuntary wrinkle in my brow and being taken aback for a moment. 

Because even though I started running as a kid and I still run a lot today, I don't actually didn’t think I ever perceived myself to be “a real runner.” 

When I think of a real runner I picture Karen Gaucher, Ryan Hall, Deena Castor and Meb Keflezighi. I tend to conjure mental images of people who have dedicated their lives to running in ways that I never could. In someway, I think I had classified a real runner as somebody who could consistently run 100 miles per week during their training periods or win races.

A real runner, I had always thought, never loses that focus on the future. Keeps her eye on the goal. She visualizes achieving her aim. Always thinks about finishing, and how it will feel.

But as I thought about that, I started to think about my friends who I think of as “real runners.” And I immediately came up with several that don't run outrageous distances. None of them run for paychecks. All of them truly love running.

John Hunt, Anjulee Johnson, Phủỏng Mai N, Sarah Graham, Mimi Jacobson-Kwok, Brynn Ewen, Laura Duplantis. These are my friends, normal people, and they are all “real runners.” In one way or another each one of them has impressed me. I have seen pictures of their runs and have been inspired. The way they have described a specific run, the way they felt, what they get from running has made me smile. 

What I realized is that their stories, their reasons for running and how their descriptions of running touches me is always about being in the moment.

It's about rows of palm trees on the Stanford campus. The smell of running through the redwoods. The beauty of oaks and pine trees passing overhead. It is about sunshine and fog and feeling alive. It's about being grateful to be fit, and able to run. It is about enjoying movement in a beautiful place, right now.

Its not about pace or distance. Its not about how many finisher medals hang on the wall. Its not about being a Kenyan. And its certainly not about how the next marathon finish will feel, tomorrow, next month or next year.

Its about gratitude. An instagram pic of a beautiful setting or a genuine smile in the middle of a long run. Its about now. The way it feels to run 47 blocks in Oakland, one way, today.

And then she asked me what my last run was like.

I didn’t think about how the run fit into my Ironman training plan. I didn’t think about the pace I kept. I described the feeling of warm sun on my shoulders, strength in my legs, 7 deer quietly feeding on the side of the trail, the amazing blue of Crystal Springs set a against a sea of green trees hugged gently by a thin blanket of clouds under a clear blue sky. I though about how that run made me feel so alive, in that moment. 

And I thought, “maybe I am a real runner.”  



Dr. Christopher Segler is a 12-time Ironman Triathlon Finisher, but more importably he is a real runner.  His podiatric sports medicine practice caters to athletes who think that there has to be way to stay fit, keep training, yet still heal an injury. He often lectures at medical conferences on the treatment of complicated running injuries, running biomechanics, and subtle fracture patterns of the foot and ankle. If you have a question about a running injury you can call him directly at 415-308-0833.  You can also learn more about running injuries at www.AnkleCenter.com and www.DocOnTheRun.com

Is this black toenail fungus or a bruised toenail from running?

I have been training for a trail run and have been running on lots of hills in Marin. I recently noticed that I was getting some dark black discoloration of my toenail. I am worried that this might be black toenail fungus infecting the toenail. How can I tell whether the toe is bruised or if I really have a toenail fungus infection? Also, what if anything should I do to treat the black toenail if it is infected?

Thanks,
David, Mill Valley, CA


Black toenails are likely one of the most common injuries I see in runners in Houston and San Francisco. There can be a couple of causes of black toenails from running.

Differences between a bruised toenail and a fungal toenail:
A bruised toenail hurts because 1) there is bruise 2) there is blood under the toenail increasing pressure between the toenail and underlying nail bed. This causes pain in the toenail when you press on it or bump the toenail on the inside of your shoes. Fungal toenails are not usually tender unless the toenail infection has been present long enough to make the fungal nail really thick.  The increased thickness can cause some tenderness, but it doesn't happen quickly.

A bruise comes on quickly, but a toenail fungus infection appears gradually. Bruising will appear within a day or two of your long run, race or whatever injury to the toenail. If you kick a coffee table once with your toe, the toenail may develop a bruise and turn black. If you bump the toe inside your running shoe repeatedly while running down hill (or because the running shoes are too tight) you can also get a bruised black toenail from the cumulative trauma. This can happen overnight.  You wake up and the toenail is black.

The changes in the toenail caused by toenail fungus happen very slowly. The color of the toenail will not change quickly.  The increased thickness, yellow discoloration, white crumbly appearance and dark color of a fungal toenail infection happens so slowly that it is almost hard to notice.

You can learn more about black toenails and toenail fungus treatment here by reading about an example of a black toenail in Houston that actually is just a toenail bruise. You can also read about from runners, blisters and black toenails here.  Learn how a bruised toenail can lead to a toenail fungus infection.

Dr. Christopher Segler, Doctor of Podiatric Medicine is Board Certified, American Board of Podiatric Medicine. He is a 10-time Ironman finisher and marathon runner. He lectures frequently to other podiatrist and foot specialists at medical conferences on the treatment of complicated running injuries and running biomechanics. He is licensed to practice podiatry in Texas, California, and Hawaii. He travels back and forth between Houston and San Francisco to see injured runners who have running injuries that need the fastest treatment based on a runner's goals and running doc perspective. If you live in San Francisco or Marin and have a running injury question call 415-308-0833 to speak to him. If you are in Houston and have a question about a running injury, call him directly at 713-489-7674. 

Marathon Blister. Should I pop it?

Question:
Hi MyRunningDoc!


I have been reading your site. This blister formed on my heel yesterday. It is huge and painful. I am running in the Avenue of the Giants Marathon on May 5, 2013 and really can't take a break from marathon training. Should I pop it?

Thanks!
W.H., San Francisco CA

Answer:
Thank you for your inquiry! That is certainly a Giant of a marathon blister. I can see how that would hurt and put a damper on your final marathon training.

There is always an advantage and a disadvantage to draining in any blister on the foot that pops up during training.

With a blister that large and a marathon that close, it is unlikely that you would be able to run the marathon without significant pain. In fact the blister is so big it would probably pop during the marathon anyway.

With most small blisters, it is typically better to let them go away on their own. If you do not drain a small blister and can keep it from getting rubbed when you are running, the fluid will gradually recede and the blister will re-adhere. It will eventually peel away revealing healthy skin underneath. It is also the least likely to get infected because you don't open the blister allowing bacteria to get inside the skin.  This actually will heal the fastest and is the safest approach.

Things get tricky when a running blister on the foot gets big.

When you have a big running blister that causes a great deal of discomfort when you run, it actually hurts because the fluid is getting pushed and compressed.  If you step on a water balloon, the balloon will squish outward under your foot. The balloon will push out and stretch as far as it can unless it pops.

So when you run on a blister like this one pictured here, the blister fluid actually pushes and continues to separate the layers of skin at the edge of the blister. This of course causes more irritation and more fluid accumulation, making the blister even bigger as you continue to run.  The only way to stop this process is to stop irritating the blister on the foot. One way to do this of course is to stop running.

If you can pad the blister and keep the pressure off of it you might be able to continue training without the blister getting any bigger.  That would be hard to do given the location of this blister on the inside of the foot and heel. It will be almost impossible to remove all the pressure from the heel inside the running shoe.

If you pop the blister, it will hurt more for the first day or two.  You can decrease the amount of discomfort by using moleskin or another type of blister cover that will stop the friction from rubbing the overlying skin. It may also be helpful to put some padding around the blister in order to decrease irritation.

If you decide to pop your blister, it is always best to drain the blister by making a small hole at the bottom edge of the blister down toward the bottom of the foot so that the fluid will continue to drain downward and out of the blister as it re-accumulates. Typically some more blister fluid will accumulate inside the blister for several days after you pop it.

The skin on the top of the blister is not what is painful. It is the skin underneath. Some people start to drain the blister and realize this and then trim off the entire top of the blister. If you are to do that in this case, it would leave an open sore about the size of a half dollar. This would of course leave an enormous raw spot that would be very painful whenever you run during training. You foot would be killing you during the marathon.

In these types of cases it is often better to simply drain the blister and leave the top of the blister intact to function as a biologic dressing. This will take slightly longer to heal than if you don't drain the blister.  However this assumes that you are of course going to continue to run, train and complete the marathon that you have planned.

It would be best to be evaluated in person or by a podiatrist or arrange a remote consultation with a running injury expert in order to get more detail, before making your final decision.  You can also learn more about blisters from running by clicking here.

Dr. Christopher Segler, DPM a marathon runner, podiatrist and 10-time Ironman Triathlon finisher who is is Board Certified, American Board of Podiatric Medicine.  He believes the best podiatry practice combines cutting edge technology with the old-school convenience of house calls. He makes podiatry house calls for runners in San Francisco, CA and Houston ,TX. He also does remote consults for runners who live outside of the United States. If you have a question, you can reach him directly at 415-308-0833. You can learn more about running injuries at www.DocOnTheRun.com 

Marathon Blisters Related to Pronation?

QUESTION:

Hi Doc,

I have just finished a marathon qualifier for an ultra coming up here in South Africa. I have always been pretty neutral footed, but with the tendency to pronate slightly. I have always had the odd blister after a very long run, but lately they seem to be worse and I am wondering if I am beginning to pronate more (can this happen over time?). I have taken a photo of some blisters that occur after a marathon. I don't like to get rid of them, I sorta let them callous for the season so its not so sore :-). Should I try pronation shoes? What are your thoughts? I use Nike Pegasus +28's. Really hope you can shed some light on this for me :-) 

Many thanks

ANSWER:

Blisters that pop up anywhere on the foot during/after a marathon are always the result of excessive pressure and friction. With excess friction the underlying layers of the skin begin to separate. Fluid accumulates and collects between the dermis and epidermis creating the fluid filled bubble that runners know as a blister. In the pictures here we can see that one blister has clear fluid and the other is dark. The dark blister implies that this is a collection of blood. This kind of blister is of course often referred to as a "blood blister." 

A blood blister insinuates more pressure or increased trauma, not just friction.

The location of the blister is important and helps a podiatrist figure out the cause. These blisters and calluses forming at the inside of the big toe joint. The medical term for this location is the "medial and plantar-medial aspect of the first metatarsophalangeal joint." 

All runners know the basic causes of blisters.  To be clear we will review:

1. Running shoes that are loose. The feet slide around with every foot strike and push off while running. The result of 26.2 miles of this is excessive friction producing blisters. 

2. Running shoes that are too tight. The feet are compressed against the inside of the shoes, increasing the risk of excess friction (with increased pressure) at parts of the shoe that move (such as the tips of the toes or ball of the foot where the break in the shoe occurs).  

3. Wet feet. Think twice about running through those garden hoses on the marathon course. Moisture in the skin can weaken the structure between the layers of skin, making blisters form with less friction that usually required. 

4. Starting and Stopping too much. If you are running with a walk/run approach, all of the starting and stopping actually takes more force (and produces more friction) than running at an even pace. This can increase your risk of blisters.  

There are other certain circumstances that can contribute to blister formation at the medial big toe joint. 

1. Pronation. As the foot pronates, the foot rolls inward, unlocking the joints in the mid-foot. The first metatarsal bone gets pushed up by the ground and the running shoe effectively twists right around the inside of the big toe joint. This of course creates excess friction and stimulated the formation of blisters during longs runs such as marathons. 

2. Bunions. Same forces at work as in excess pronation, with the added pressure at the bunion stick out and presses against the inside of the shoe. 

Solutions:

1. Blister-prevention socks that have 2 layers that can glide past each other. In effect, you beat up the socks instead of the skin.

2. Custom orthotics or over-the-counter inserts that support the foot, stabilize the subtalar joint and decrease pronation. If properly fitted and constructed, inserts can slow the pronation that contributes to the problem. 

3. Motions control running shoes. Stability running shoes decrease pronation with aggressive medial posting on a stable platform.  They are heavier, and stiffer. Beware-if you have high arches they can increase your risk of shin splints and stress fractures. 

4. Build mileage gradually. This gives the skin a chance to toughen up and form protective calluses without blistering.  

When in doubt. See a local podiatrist for a complete evaluation, running shoe analysis and gait exam to assess your running biomechanics. 

Dr. Christopher Segler, DPM a marathon runner, podiatrist and 10-time Ironman Triathlon finisher who is is Board Certified, American Board of Podiatric Medicine.  He believes the best podiatry practice combines cutting edge technology with the old-school convenience of house calls. He makes podiatry house calls for runners in San Francisco, Palo Alto, Sausalito, Pacifica, and Corte Madera. He also does remote consults for runners who live outside of the United States. If you have a question, you can reach him directly at 415-308-0833. You can learn more about running injuries at www.DocOnTheRun.com 

Barefoot Running: Good Idea or Bad?

This weekend Dr. Segler was invited to speak at the International Foot & Ankle Foundation (IFAF) conference in South Lake Tahoe, CA. The group of attendees includes podiatrists, sport medicine specialists and foot surgeons from all over the United States.

The IFAF is a premier nonprofit educational organization established in 1979 dedicated to providing the highest level of continuing medical education programs in exciting venues around the world and providing increased revenue to help support continuing education, research, the Swedish Podiatric Surgical Residency Program, the Franciscan Foot and Ankle Institute and the NW Podiatric Surgical Biomechanics Research Laboratory in Seattle, Washington. Dr. Segler has become one of the featured speakers at IFAF events around the country.

On Friday Feb 1, 2013 he was lecturing on "Barefoot Running: Good Idea or Bad." The talk centered on his experience with elite triathletes, serious marathon runners and recreational runners with whom he has worked in the San Francisco Bay area. Dr. Segler explained that the key to understanding the trend is to appreciate the goals of runners embarking upon a minimalist path, while appreciating the potential biomechanical limitations and training pitfalls that can lead to running injury. He endorses natural running form as a cross-training tool for many runners and triathletes.

Dr. Segler was asked, “Do you feel that you are helping other physicians here at the conference by sharing your experience in treating runners and helping them address the unique biomechanics of running injuries?”

Dr. Segler replied, “Well, I certainly do feel honored that the IFAF has invited to me speak about my experience, but I personally really feel that I am the one learning and gaining the most at these events. When invited to share the stage with a panel of experts like this it forces me to pay very close attention to my work and my knowledge base. I actually have textbooks in my office written by the IFAF faculty who are also lecturing here. These are the people I have admired since I was in medical school. The expectations are high and those expectations force an attention to detail that requires learning.”

Dr. Christoper Segler is a 10-time Ironman Triathlon finisher who combines his personal experience as a runner and triathlete with his nationally recognized expertise as a running injury specialist in order to help injured runners return to running as quickly as possible. He practices podiatric sports medicine in San Francisco. Being passionate about running and the benefits it brings to athletes, he believes that all injured runners should think it is a reasonable goal to return to running. He believes that it is the physician's job to determine the patient specific goal of the patient and help achieve that goal not just find a different activity. He believes that running injuries are not a sign that running should be abandoned as an activity, but that there is a problem that has simply not been identified and adequately addressed. you can learn more about running injuries and even view the PDF of the lecture Dr. Segler gave at Lake Tahoe by visiting www.DocOnTheRun.com

Can I Continue Running With This Blister?

We receivd an email inquiry from Julie who is currently training for a marathon. She recently injured on of her little toes and wants to resume her training.

She explains. "I have had this blister now for a week. I had also tripped over a bike rack which bruised my toe as well. I am on antibiotics and they took X-rays to confirm my toe was not broken. It was not broken but very infected. I was training for a marathon and want to know if I can continue running or do I need to wait longer for it to heal."

As a sports medicine podiatrist the primary concern with a blister is of course to help the blister heal as quickly as possible so that the patient can resume marathon training without any significant loss of fitness.

The basic tenets of blister treatment involve the following:

1. Provide mechanical protection of the blister. This means to use any combination of reduced activity, shoe modification, padding, etc. to stop rubbing and irritating the wound. If you continue to apply shear forces and friction, the blister will take much longer to heal, and could even get worse.

2. Optimize a moist environment of the wound to facilitate healing. This means that you want to keep the wound properly hydrated. The wound has to be moist, but not too moist. If a blister is actively draining, the dressing should absorb the exudate to prevent the excess moisture form breaking the tissue down further. If the wound is too dry, then a dressing should be used that will add moisture sufficent to promote healing.

3. Reduce the bioburden of the wound. "Bioburden" is a term used by wound care specialists that refers to the well-know negative effects of bacteria colonizing a wound, or worse yet, infecting a wound. Your skin is covered in bacteria. This not a comment on hygiene; it is a natural state. Any open wound will quickly become colonized with bacteria as well. If there is an excessive amount of bacteria feeding in the wound, the wound healing process slows. Many wound care products are designed to impede the growth of bacteria or wash the bacteria away. But not all are created equal. Some commonly used wound-cleansing substances such as dilute bleach, hydrogen peroxide and povidone-iodine kill off bacteria, but unfortunately are also toxic to the cells trying to heal the wound at the base and edges of the blister.

Much worse than a "colonized wound" is an "infected wound." The difference is that an infected wound is one where the bacteria is actually directly damaging the tissue. This is the case described above.

It appears from the picture and description provided that this runner's toe has not been caused by the exceeding common friction from running shoes, but is in fact a traumatic injury, more likely causes by a direct blow when tripping over a bike rack.

When this kind of injury occurs two things can happen.
1. The toe (or at least on of the phalanx bones within the toe) can easily break.
2. The nail plate can become separated from the nail bed leading to a nasty infection.

This type of injury has to be treated much differently than a standard friction blister.

The first concern is to treat the infection. This might be accomplished through the administration of prescription oral antibiotics, drainage of the blister and removal of pus in a podiatrist's office, and perhaps, even remove of the nail plate. Deciding which of these are appropriate would require an in-person evaluation with a podiatrist.

The second concern is the possibility of fracture. Little toes get broken all the time with the kind of injury described. The reason this is so worrisome is that if one of the bones in the toe is broken, the infection in the skin and surrounding soft tissue could easily spread to the bone resulting in osteomyelitis- also known as a bone infection. Bone infections are serious and are the primary cause of amputation of toes.

Before returning to running this runner (and her doctor) would have to be certain that the toes wasn't broken and the infection was well on its way to healing. Once that has been accomplished, it would be necessary to have a podiatrist who treats runners often evaluate the runner's shoes and determine the best way to offload the toe so that it could continue to heal with any irritation. She should then be able to get back to training for her marathon.

Dr. Christopher Segler is sports medicine podiatrist who practices in San Francisco. He is an active runner and triathlete who is competing in 1 marathon and 4 Ironman triathlons in 2012. His practice is limited to active runners and triathletes. You can learn more about running injuries at www.DocOnTheRun.com and www.AnkleCenter.com

Houston Marathon Race Report

2011 was a year plagued by urgent sports medicine consults and surgery. With a sports medicine practice structured to provide rapid access to aching athletes, my own training seemed to get buried. So I planned 2012 to begin as a year of racing myself back into shape.

The Chevron Houston Marathon, just two weeks into the new year seemed a great place to start. This was my third year registered for Houston, but would be my first attempt at this event. I was a no-show for both the 2010 and 2011 editions of the marathon, again forced to stay in San Francisco to take care of patients.

Just two days before my departure this year I would have a work matter come up that threatened to thwart my marathon again. I re-booked the flight, so I could fly in at the last minute. Sleep deprived running would be better than no running. A plane with a “broken hose inside the wing” left me anxious and sitting at LAX for an extra 5 hours, but eventually I made it to Houston.

I was excited to run as I would be joining my sister and my brother-in-law. It was his first marathon. My sister Laura however is a veteran.

After a few hours of sleep the three of us were up in the dark and parked in downtown Houston. The temperature was 41 degrees but forecasted to rise to about 60. Perfect!

Because 2011 was so busy with work, I hadn’t actually run more than 13.1 miles since Ironman Texas. That was eight months ago. So the plan for my race was simple. Run steady. Don’t walk. Don’t do anything dumb enough to cause an injury.

I went out for a test run about a week ago to plan my pace for the marathon. I ran 13.1 miles, from the San Francisco zoo, along the Great Highway, up through Golden Gate park and back. I covered the half marathon distance in 1:42. So I figured that a 3:40 marathon would be a reasonable goal.

The Houston Marathon is a huge event, but the organization was great. Runners were separated into corrals based on expected pace. I found the 3:40 pace crowd and waited for the start.

After the mayor spoke and the national anthem was sung, the wheelchair start was off. Ten minutes to gun-time. I took off my warm-up pants and tossed them over the fence into a growing pile of running wear that was to be gathered and donated to the homeless. It was cold, so I kept the sweatshirt on.

The gun went off and anxious shuffling commenced. Thousands of runners trying not to bump into each other, trudging through the shoot, pointed out of town. Like magic, as soon as I hit the start timing mat, running began. Almost instantly the mass was at a seemingly coordinated 8:00 min per mile pace.

As we rounded the overpass, it was a fascinating sight to see. Dawn cast an orange hue on the horizon. There ahead, as far as I could see was a street stuffed with a colorful gyrating mass of bobbing heads flowing through the street.

One mile in and I was finally warm. I bid my sweatshirt goodbye and tossed it into a pile of clothes on the sidewalk. A couple of slow runners suddenly appeared in front of me, creating a challenge to dodge them, without elbowing anyone or stepping on any heels. Time to ignore the crowd and stay on pace.

Before I knew it I was out of downtown and in the Heights. Five miles into the race I passed my sisters house, which happens to be right on the course itself. There on the sidewalk were my twin nephews who offered up a matching pair of enthusiastic high fives.

We kept rolling south through Montrose and towards West University. Bands played. People cheered. A priest stood in the street, waiving a palm frond dipped in holy water, blessing the flowing crowd of runners.

The course continued, flat as a pancake, through historic neighborhoods, under the shady tunnel of trees near Rice University and out through Memorial. As we hit Memorial Park, I had my last energy gel and knew I would make it. All I had to do was keep running and I would be in somewhere close to my goal.

Just then I saw my friends Henry and Josh cheering wildly, a great boost for the final stretch. The last few miles had the only real sequence of hills. But my frequent runs at Lake Merced, Crystal Springs and through Golden Gate Park, made them seem like speed bumps. In the last 4.5 miles I passed 162 runners, but only got passed by 10.

Right turn on Shepherd then left on Allen Parkway. The crowds got bigger, the cheers louder and the buildings of downtown steadily grew into the sky. As I felt the headwind pick-up, I realized it was the wind funneling between the skyscrapers. I was downtown, just blocks from the finish. I felt great and was tempted to turn up the juice, but then the voice of reason rang through me head…”you haven’t run more than 13.1 miles in 8 months. You have Ironman St. George and Ironman France coming up...DON’T DO ANYTHING STUPID!”

And so I stayed on pace. Round the corner and down the longest finish chute I have ever seen. Across the line in 3:41, actually a new PR. Today, I will call that success.

2012 is officially off to a very good start.

Dr. Christopher Segler is a marathon runner, 6-Time Ironman Finisher, and sports medicine podiatrist in San Francisco. He lectures to other foot and ankle surgeons at medical conferences on the topic of complicated running injuries. His practice focuses on runners and triathletes who have complicated injuries and cannot seem to get an accurate diagnosis. You can learn more about foot and ankle injuries at www.AnkleCenter.com and learn more about housecalls for runners in San Francisco at www.DocOnTheRun.com. He performs second opinion consultations for runners and triathletes world-wide through www.RunnerSecondOpinion.com

Custom Orthotics For Runners by San Francisco Podiatrist

Running places a tremendous amount of stress on the feet and legs. When you train for a marathon, the goal is to create just enough stress to stimulate an increase in running endurance without so much stress that an injury results. Running injuries like shin splints, stress fractures and tendonitis are common as mileage and intensity increase during training.

Slight imbalances in the foot and ankle can result whenever there is too much pronation. Other mailalignments (such as a forefoot that is slightly tilted relative to the rearfoot) can lead to increased stress to certain bones in the feet. At the same time, any of these biomechanical problems can increase tension and overuse of tendons that lead to tendinitis.

Although I get lots of requests to make orthotics for marathon runners and triathletes here in San Francisco, I am often surprised how many athletes don't really understand what an orthotics is and how it works. A custom orthotic made for a runner is not just an arch support or a shoe insert with extra cushion. Custom orthotics are custom made footbeds (custom built based on a foot doctor's prescription) that control abnormal motion and correct mechanical imbalances.

You can learn more about custom orthotics on our website or by simply watching the video below.



Dr. Christopher Segler is an award winning foot doctor practicing podiatry and specializing in running biomechanics in San Francisco. He specializes in house calls to help busy athletes who don't have tim to get the foot doctor. He makes housecalls all around in San Francisco, Mill Valley, Palo Alto, Berkeley, Corte Madera, San Rafael, Oakland, and San Jose. If you are a runner with a history of nagging injuries, arch pain, flat feet, or tendonitis, he can come right to you to make your custom running orthotics that will not only decrease your risk injury. If you just have a question about custom orthotics made for runners, you can call Dr. Segler directly at 415-308-0833.

How to Tell If You Have a Stress Fracture In the Foot by San Francisco Running Podiatrist

Last year just a few weeks before Ironman Louisville, I got an out-of-state call from a very worried triathlete. He said he had been ramping up his training for the big race. He had slowly been building milage over the past year. But then he started to get an aching foot when he ran. Slowly it turned into throbbing foot pain when he would run. And by the time he called, it was starting to hurt even while he was walking.

He was really distressed.

As a runner and prior Ironman finisher, he had been running long enough to know that a stress fracture in the foot was one of the most likely injuries that could force him to stop running. He was worried he wouldn't even be able to show up on the starting line at Ironman Louisville. The good news is that we were able to manage the stress fracture and he did complete the race without incident.

Training for any distance event (whether a half-matrathon, marathon or Ironman) can lead to a stress fracture in one of the metatarsal bones of the foot. But if your foot aches, there are some simple ways to tell how likely it is that you have a running-related stress fracture. This video explains how you can tell if you might have a stress fracture in the foot.

To learn more about stress fractures, visit the most comprehensive running injury site in San Francisco. All of the running education information has been created by San Francisco's Award-Winning Foot Specialist and Ironman Triathlete Dr. Christopher Segler. He's not just a running specialist who writes about running injuries, but he is a real runner as well.

What If I Have a Stress Fracture and Keep Running on My Sore Aching Foot?

I was heading to Kezar stadium to run intervals when I got a call on my San Francisco Sports Medicine Podiatry practice phone from a runner with a typical question. He explained he was having a mild aching sensation in the foot when walking around, but it has been getting worse when running. He said he thought it was slightly bruised on the top of the foot, but couldn't remember dropping anything on it. He had been trying to figure out whether or not it might be a stress fracture. Because he has ben ramping up his training for a marathon, his main question (of course) was "Well what if it is a stress fracture....what is the worse thing that can happen if I keep running on the foot?"

To help him understand what could happen if he does have a stress fracture and keeps running on it, I told him he could read all about the SF podiatrist point of view on "Can I run with a stress fracture in my foot?"

I also sent him the link for the video on "What If I Run On a Stress Fracture - By San Francisco Sports Medicine Podiatrist."


Dr. Christopher Segler is an award winning foot surgeon and podiatric sports medicine specialists in San Francisco. He developed a house calls based practice to serve active athlete, marathon runners and triathletes who can't waste their free time driving around town or sitting in a doctor's waiting room. If you have a question about a possible stress fracture, you can call him directly at 415-308-0833. You can also learn more at stress fractures at San Francisco's Best Running Related Podiatry Site or MyRunningDoc.com.

To Pop or Not To Pop: Blister treatment for runners explained by San Francisco's Running Podiatrist

Dr. Oz recently ran a segment on his television show instructing his audience to pop blisters whenever they occur on the feet. He went on to explain that if you successfully get all of the fluid out, the top layer of the blister will form a adhere down to the tissue underneath and create a "biologic dressing."

While this may be sound advice for a typical healthy woman who gets a blister from a new pair of high heels, the real question for Bay Area runners is: "Should I drain a blister" if I am a runner training for a race such as a marathon or triathlon?

The best answer is "sometimes you should, and sometimes you shouldn't."

The medical term for the type of blisters on the feet when running are "friction blisters." Blisters on the feet occur from a combination of skin friction and pressure. When your foot slides around inside the running shoe, you get friction. Rubbing the skin over and over in one spot (such as the back of the heel or ball of the foot) causes the layers of the skin to begin to separate. Fluid then seeps into this newly created space between the layers forming the blister.

Keep irritating the area and the blister continues to get bigger. Even if you simply continue to apply pressure to the blister (like pressing it against the heel counter inside the running shoe) it will continue to get bigger. This is because the fluid will try to spread outward and keep separating the skin layers. Then even more fluid seeps in to make the blister bigger.

If you keep rubbing the blister long enough, the skin on the top of the blister will tear effectively popping on its own. The blister then starts to ooze relieving the pressure as the fluid leaks out. So should you take charge and drain it yourself?

What sports medicine podiatrists know about blisters in runners is:

1) small non-painful blisters heal quickly
2) large painful blisters hurt less if drained and not irritated, but hurt more and have a slightly higher risk of getting infected if they are drained and the activity (such as running) is continued
3) blisters with the overlying blister roof removed will heal, but hurt more initially

So If you are runner with a small blister on a toe and it doesn't hurt don't drain it. It will heal quickly and has a very low risk of infection. If the fluid can't drain out, bacteria can't get in. If you have a blister that is small, put a felt pad around the blister. You need a donut shaped or U-shaped pad for this to work. You need to put the pressure around the blister and not on the blister. This will stop all of the rubbing that could make the blister get bigger. It will also stop the blister from hurting.

If you running a marathon or competing in an Ironman triathlon and get a huge blister that makes it hard to walk after the race, drain it. You can do this by poking a small hole at the edge of the blister. Heat the needle or soak it in rubbing alcohol. This will sterilize the needle so that you don't introduce any infection causing bacteria when you puncture the blister.

Cover the blister with a bandage that will soak up the fluid as it continues to leak out. If the fluid starts to build up again, then repeat this process and drain the fluid again. Marathon runners with big blisters may have to do this a couple of times. The blister can be quite irritated after running 26.2 miles.

So what are the "exceptions to the rule" about popping or draining blisters in runners?

1. If you notice the blister at mile 13.1 and still have another half-marathon to go, don't pop the blister. This is where the advice from Dr. Oz doesn't fit with runners. If you drain the blister on your heel then continue to run, more fluid will seep under that skin. The skin will slide back and forth. If the drained blister skin slides around, it can't work as a "biologic dressing" because it never has a chance to stick to the underlying raw area. The roof of the blister may also tear. That is what happened in the blister pictured above. All of the rubbing of the heal inside the running shoe caused the blister to rip open. If the roof of the blister tears, it needs to be removed (called "de-roofing" by podiatrists).

If the blister is drained, you need to secure the overlying skin in place with a dressing. Wait until the race is over. If you drain it mid-race it will hurt like hell, there is a higher risk of infection and it will take longer to heal. You also need to wear a pair of shoes that won't rub on the raw blister after it has popped. So once you drain the blister, apply a dressing that will hold the skin securely in place. Change the dressing daily. Studies show that hydrocolloid dressings works best to bake blisters heal fastest. But there is NO evidence than antibiotic ointment helps blisters heal any faster.

2. All blisters should be drained, completely de-roofed and treated by a podiatrist if you are diabetic. The risk of infection is much higher in diabetics. A blister anywhere on the foot in a diabetic runner is a medical emergency. I have personally performed many amputation on diabetics where a blister became hugely infected and spread to the underlying bone. Seek immediate medical attention if you have diabetes and a blister anywhere on the foot, heel or toes.

Although it is easy to prevent blisters, they still often occur in runners. In fact research shows that blisters on the feet are by far the most common running injury reported among marathon finishers. If you get a blister on the feet, treat it right and it will heal quickly so you won't have to miss much training at all.

Dr. Christopher Segler is a sports medicine podiatrist in San Francisco with a focus on runners. He is also a marathon runner and Ironman triathlete himslef. He makes house calls all over the Bay Area to treat running injuries like blisters, stress fractures and Achilles tendonitis. If you have a question about a running injury you can email him or call (415)-308-0833 to reach him directly. For the best source of running injury prevention information in the San Francisco Bay Area, visit MyRunningDoc.com or AnkleCenter.com.

Runner's Pedicure???

Question: "What in the world is a runners pedicure!!! What I am looking for is someone who knows what happens sometimes when you run a half or full marathon. Yes the dreaded black toenail. My toes have mostly recovered but my girlfreind is insisting I get them in shape or keep my shoes on!" - Rick J.




Answer:As a Bay Area podiatrist and active runner (marathons and Ironman) I can tell you that you don't necessarily have a fungal infection just because the toenail is getting thicker and uglier. There is a very common condition among distance runners and triathletes. It is often referred to as "Runners Toenail." Podatriss call it "traumatic onychauxis." If you run a marathon or half marathon and get the black toenail, you have caused enough trauma to the nail bed (under the nail) to bleed. It is basically a bruise or bllod blister under the nail. Repeatedly beating up your toes in this way leads to the root of the nail getting smashed, deformed and becoming missahpen. Then the toenail grows out thicker. It may be greyish, or yellowis in color and often looks like a fungal nail, but it may not have any fungal infection. A pedicure can often thin the nail and return more of a normal appearance to it. Podiatrists can also prescribe topical solutions that decrease the buildup of keratin on the nail that makes it look like a fungal toenial. The bad news is that there is no "cure" for runners toenail. But you can keep your toenail looking presentable with a pedicure. If it gets worse over time (and you haven't had any more episodes of black toneails) it might be a fungal toenail infection. The only way to know for sure is to see a podiatrist. Your foot doctor with then take a sample of the toenail and send it off to a lab for anlaysis. A test called a PAS reaction will determine whether or not there is any fungus living within the nail plate. If there is no fungus, then you have "traumatic onychauxis" (runner's toenail, in plain English. You can also visit http://www.MyRunningDo... for more info. Best of luck! - Dr. Christopher Segler, San Franciso Podiatry House Calls

Videotaping your gait to improve running stride

Question:
I've been reading alot about heel-striking lately, and the effort to improve your stride. Now focusing on 70.3's and IM's, I'm beginning to question if I should review my stride and look for ways to improve it (if there is one).
Thanks!
Robert


Answer:
Running stride alterations to improve efficiency can help improve your marathon and Ironman triathalon time considerably. In these endurance events it is all about conserving energy and being efficient. Its not really about how fast you go, but how little you slow down.

I am a podiatric surgeon with an area of expertise in running biomechanics. I am also a 4-time Ironman finisher. I am not particularly fast (P.R. of 10:59:57), but have been improving considerably over the past year by simply modifying my stride. I now run more upright/forward, at a much higher cadence and with a shorter stride. I also have much less heel strike.

You may simply be able to evaluate your stride by looking at the wear pattern on the soles of your shoes. That is why I always examine my patient's running shoes during their evaluation. Most podiatrists specializing in running injuries will do this.

Having an expert watch you run is helpful. Your local podiatrist, triathlon coach, running coach, etc. can help. Short of this, you should capture some video (from the rear and from the side) so you can see what you foot strike is currently, and how it improves over time.


Dr. Christopher Segler is an Ironman triathlete and award winning foot doctor specializing in endurance athletes. He lives and trains in the San Francisco Bay Area.

McGlone's Kona Return after Achilles Injury Today on NBC

A minor ache in the back of the leg down near the heel may just seem like a minor annoyance at first. But if ignored for too long, Achilles tendonitis can keep you from running and cycling for months.

This is precisely what happened to Ironman 70.3 Champion Samantha McGlone. In 2007, the fiercely competitive former Olympian showed up in Kona and finished second in the Ironman World Championships, just minutes behind Chrissie Wellington. But a year later, she found herself sitting on the sidelines recovering from an Achilles tendon injury. Reportedly she spent about 6 months with no running or cycling at all. She struggled with the problem for nearly a year and a half.

Runners and triathletes are particularly susceptible to Achilles tendon problems. In part, this is because they are so determined to set goals and stay on track with training. But whether you are a marathon runner, an age-group triathlete, or someone chasing an Ironman World Championship, it can be hard to back off just because you have a little pain in the back of the heel.

Achilles tendonitis is really nothing more than inflammation within the Achilles tendon. Usually, the pain and swelling is in an area just above the tendon's attachment to the heel bone. This is an area known to be prone to injury due to decrease blood flow to this part of the tendon.

Inflammation in the Achilles' tendon is usually short lived. However, if you continue to run with Achilles pain, the tendonitis turns into tendonosis. This is what happened to McGlone.

Tendonosis is a degenerative condition where chonic inflammation essentially breaks down the collagen in the Achilles fibers. It gets mushy and weak. Many times surgery is required to clean out the tendon. Physical therapy can help speed healing. But, as Maglone learned, it won't just go away on its own. You have to see a sports medicine focused foot and ankle surgeon to get better.

Fortunately Sam is back in action. And today on NBC, we can all watch her chasing an Ironman World Championship in Kona, Hawaii. Although her recovery has been longer than the Queen K Highway on a hot windy day, she will surely show her fire and determination as she takes on the challenge on the Big Island.



Dr. Christopher Segler is a multiple Ironman Finisher and award winning foot and ankle surgeon. He lives and trains in the San Francisco Bay Area. To learn more about Achilles tendonitis, runner’s heel pain, stress fractures, bunions and other common causes of foot pain, visit http://www.MyRunningDoc.com or http://www.AnkleCenter.com .

Ironman Florida 2009 Race Report and Story November 7, 2009 by MyRunningDoc

2 DAYS to RACE DAY
When the rising sun finally cast enough glow on the sand for me to see, I walked out onto our balcony. I looked toward the Gulf of Mexico and saw water as smooth glass. A gentle breeze stirred only the slightest rustle in the palms between our hotel and the beach. It was Thursday morning, and time for a practice swim.

We had already been up for a couple of hours. I could lie and say that it is because I am a dedicated triathlete, but the reality is more about life with a two year-old. I made some coffee in our french press before gathering my wetsuit, goggles and earplugs to head to the beach.

Alex was already enjoying his Ironman cowbell while I put on my wetsuit at the Gatorade practice swim area. I headed down and waded into the water to blend in with the other hundreds of triathletes making their way out along the big yellow and orange pyramid shaped buoys.

The water was incredibly smooth and crystal clear. The visibility was much better than my local pool. I swam about halfway out along the course and could see the bottom the entire time. As I would rotate and look to the side to breath I would catch a fantastical underwater view of herds of googled folks in wetsuits stroking in unison. Everyone looks the same out there.

I made it back in, rinsed off and went to check in. Time for play with Alex and Paige in the pool and waterpark.

1 DAY BEFORE RACE DAY
In the interests of time (and convenience) I decided to swim from the beach right behind our hotel. I headed out alone into the gulf. As I waded out I saw a stingray just in time to miss stepping on him as he flew along the sandy bottom. I started to swim instead of wade. A moment later I saw a second stingray. I realized how nice it is to swim in clear open water as opposed to other venues where the water is usually closed to swimmers. This was the first triathlon where I could easily see more than a few feet in any direction.

While swimming, I felt more like I was snorkeling. Watching clams hop along the ocean floor, noticing sand dollars resting peacefully, small fish darting about. Then I saw a jelly fish. I was glad I was wearing a wetsuit. Then I saw another, and another. Next thing I knew I was in a school of dozens of jelly fish. I figured I had gone far enough so I turned around and swam back in.

My wife was building sandcastles with Alex when I got back on shore. I rinsed off, put on my bike gear and headed out for a quick ride. It was slightly windier than the day before, but still perfect. I rode about 15 miles at an easy pace. As soon as I got back, I swapped my bike for a pair of running shoes and off I went on a short run.

After my final tune-up workout, I showered and we ate breakfast, I took my bike and transition bags down to the transition area. With everything turned in, nothing left to do but, eat sleep and wait.

RACE DAY!
The alarm only buzzed twice at 4:30 a.m. and I was wide awake. I made coffee and a peanut butter and jelly sandwich. Shower, shave, bodyglide (in all the important places), band-aids on the nipples, dressed and I was ready.

I made a quick post on Facebook to let my friends know that I felt good and would go for a new PR. We got Alex in his stroller, handed him his cowbell and clapper and we were off the the start.

In the hotel lobby, athletes with bike pumps and goggles in hand were heading out into the dark. I saw several that had a familiar expression and look in their eyes. I had seen this expression before on the faces of climbers at the base of El Capitan. Its fear.

They were probably first timers. I bet I had that look when I showed up in Arizona to see if I could go 140.6 miles in one day. I do know that until my first Ironman was over, I wasn’t really sure.

We drove down in the dark predawn chill to the start. Paige went to find parking while I went in to air my tires and fill my Aerodrink bottle with fluid. With the bike ready, I went find to a porto-potty. Hint...its always at the end of the longest line. But I had plenty of time.

While I waited, I watched the palms waiving in the wind thanks to Tropical Storm Ida brewing way off in the Gulf. I knew that the winds would be out of the East at about 10 mph, but not too gusty. The flat water would be gone today.

With the sun finally up, I put on my wetsuit and gave all of morning clothes to Paige. I tucked my timing chip way up under my pant leg, to protect it from getting pulled off by thrashing swimmers. The professional’s start was my signal to head down and find a place to line up. I kissed Alex and Paige goodbye and headed onto the sand.

SWIM 2.4 MILES
The start of any Ironman is intimidating. But Florida is really spectacular. You get a running start from the sand in a crowd of 2,400 over-hyped type-A’s. And they are all aiming for the same line of buoys.

I knew that the best place to start would be to the left, directly in line with the buoys stretching out to sea. This would be the shortest distance. This of course, would also be the most crowded, and hence, most dangerous place to be. I was weighing this, recalling that a father of two young children was killed in the swim here a couple of years ago.

A lot of other people must have been thinking about this too, because they were very spread out. It seemed like some people were so intent of staying out of the crowd that they were going to start from the Alabama state line. I just figured I would start on the left, but start slow enough to let the speed demons get ahead and not clobber me.

The cannon fired and... run, paddle, dog-paddle, bump, gasp, swim, swim, bump, swim. It was a lot like swimming with drunk hockey players. But I was ready. I learned my lesson in Louisville where I got hit in the head, sending my ear plug to the deep recesses of my ear canal. I felt safe and secure in the malay, having tied dental floss around them as insurance this time.

The whole first lap was just plain chaos. I never went more than a few strokes without either hitting or getting hit by someone. At the first turn buoy I swam right over someone as someone else swam right over me.

I then saw something waving in the water and flapping on my wrist. I realized that in the tussle someone had caught my ID band and pulled it apart. This was not good. You are required to keep it on until the event is over. I wadded it up and stuffed it up my wetsuit sleeve, so I could try to get it back together once I got out of the water.

After rounding the second turn buoy, I saw some jelly fish. Most were comb jellys like the ones I had seen the day before (that don’t sting as I found out with a little internet research). However there were a bunch of moon jelly fish too. It seemed like they stayed about 10 feet down under us, which was just fine with me.

With 1.2 miles down we all ran up on shore like a bunch of seals escaping a trolling great white in some National Geographic special. Aim for the timing mat and back into the water for the second lap. The second lap was much calmer than the first. In no time I was back on shore, wiggling out of my wetsuit. 1 hour 17 minutes… 3 minutes ahead of schedule!

T1 - SWIM to BIKE TRANSITION
I had some trouble with locating my transition bag, but found it pretty quickly. The volunteers really do a great job helping all of the frantic athletes. Knowing the changing tent would be packed, I started to get dressed outside. I also got my wristband back on. Luckily it had just come unsnapped and wasn’t broken. I tried to get my Garmin started and began putting on my heart rate monitor, sock, etc, while the GPS searched for beacons in the sky.

By the time the Garmin was online, I was ready to go. But I still had to make the required hike through the change tent. It was like getting through the Bay Bridge Toll Both at rush hour. It took minutes that seemed like hours to wade through the jammed crowd.

Clip-ity-clop, clip-ity-clop, out of the change tent through transition and onto the bike. I grabbed my bike and jogged to the mount line. A painfully long 11 minute transition. On the bike and away I go.

BIKE 112 MILES
I was really ready to go. I was moving at 22-23 mph, eating my first pack of powergel and taking in some fluid. I was still wet and felt a little chilled moving through the 50 degree air but knew it would warm up soon. Realizing I had a slight tailwind out of transition, I picked up the pace.

The ride was mostly flat with some long half-mile hills that are just enough reason to stand up and get out of the torturous saddle, but not enough to wear you out. There was some wind, but not too bad. There was however a huge crowd.

For almost the whole first half of the bike leg I was passing people, continuously. The crowds would get clogged up at the aid stations and it was distracting. I did see some people who were obviously deliberately drafting, but not too many. More than anything else, it was just congested. Often it was hard to get through these packs. A couple of times I was over the center-line as I passed some 3 or 4 rider wide packs.

Somewhere around mile 20 or 30 I was getting ready for my aid station routine. I popped a salt cap in my mouth and took a sip of water. Next I sat up, pulled the cap of my the aero water bottle nestled in my aerobars and got ready to grab water, gatorade and powergel as I cruised by.

I slowed down to about 18 or 19 mph and snathced a water bottle from a jogging volunteer. I immediately squeezed about 16oz. into my bottle and tossed it aside just in time to grab some gatorade and pour it in. Then I yelled “gel” and a kid started running down the course ready to hand it off. As I flew by I clenched the foil packet tight and reached for aerobar to upshift and start accelerating again.

It was then that I felt a thick sticky ooze running through my fingers and down the back of my hand. The kid had even gone the extra mile and opened the packet for me. By the time I realized this, my shifter was coated in thick sugary goo and my hand was basically glued to the aerobar.

At the next aid station I grabbed two bottles of water. After thirty minutes of dribbling water on my hand, bar, and shifter, I was free from the energy-gel-fly-trap.

About this same time time, I realized my right pedal cleat was loose and shifting about. I couldn’t believe I hadn’t checked them in months. I just hoped it was hold up through the final 50 or 60 miles.

At about mile 75 a yellow jacket flew straight into the front vent on my aero-helmet and stung me on my poor defenseless bald head. I was frantically trying to get my hand under the helmet to squash him, but didn’t want to risk a DQ from a chinstrap violation. So we buzzed along together for about 7 miles. Twenty minutes of a bee-in-my-bonnet-later, I pulled over at an aid station, dismounted, took of my helmet, and the assailant flew away into the pines.

As I pedaled back toward town, it felt great riding with a tailwind at 26-30 mph. But then the last 10 miles are right into the wind. I tried to relax and slow down on this stretch to make sure I could run off the bike.

Once I slowed, a guy pulled up along side of me and said he noticed I was shifting a lot. I was trying to explain that I was just trying to find a rhythm, but was having trouble with my cleat. Then a woman screamed and we both turned our attention back to the road. The two of us swerved away as she turned sideways, went skinny, and squealed as we narrowly missed her. Hard to imagine walking in the bike lane as a couple of thousand triathletes head your way.

T2 - BIKE to RUN TRANSITION
When I dismounted, I checked the time. 5 hours and 18 minutes. Pretty close to the 5:15 I had planned. My second transition went smoothly. Start the other Garmin, helmet off, hat and Newtons on. Out on the run course in just over three minutes.

RUN 26.2 MILES
I set off on the two-loop run course at an easy pace. I did the math and realized that to finish under 11 hours I needed pretty close to a 4 hour marathon. I aimed to hold a 9:00 per mile pace for the first 10 mile warm-up. I had the idea that I should also shoot for a sub-4 hour marathon, but didn’t want to risk overdoing it and missing my goal finish time.

Several times during the run I would suddenly hear a high-pitched “CHRIS!!!!” and see Paige and Alex waiting and waiving on the side of the road. I paused just long enough to kiss Alex on the forehead. As I ran off, I could hear the drifting away of his clanging cowbell and “godaddygo…”

The second 10 miles were a little harder and somewhere I lost some minutes. Overindulging on the pretzels at the aid station, I guess. With only about 10K to go, I realized my 11 hour goal was within reach, as long as I didn’t waste any time.

As I rounded the turn at the park to head back on my second and final lap, I walked through an aid station to drink some gatorade and water. A guy started talking to me, saying he was just on his first lap.

He had been rear-ended on the bike. He had some dizziness and they almost didn’t let him continue. He started telling me the whole story. While I was interested, I really didn’t have time to listen. But I felt bad for him and didn’t want to be rude and add to an already tough day for him.

But the second he came to stopping point, I said, “Well... good luck buddy... you’ll do great!” and launched into a run. Three miles to go I came to the sobering realization that I was in trouble. These would have to be my fastest miles of the entire day if my 11 hour goal was going to materialize.

I saw an aid station just a couple of blocks ahead. I figured that when I got there I would sip some chicken broth, do some more math and re-assess. My body was aching, my neck was stiff, my back hurt and my quads were vibrating. I realized that even if I finished in 11 hours and 5 minutes, that would be respectable. It would still be a personal record by almost an hour. I also knew no one would really care.

But then I thought about about looking at the time of 10:59:59 I had posted on my refrigerator and as a bookmark in whatever book I was currently reading. I thought about the “21.33” taped on my bike stem to remind (every time I rode) of exactly how many miles per hour I needed to ride to reach my goal. I suddenly remembered that on 7 different days in past 9 weeks I had run mile repeats on the track in the rain and thunder so I would be able to RUN today. And suddenly 11:anything just wouldn’t do.

And so I RAN.

I ran right past the aid station and said “hold chicken broth.”

I ran that mile. And the next, staying wide of the aid stations to fly by the crowds reaching for water and bananas. And when I saw the lights of the finish chute and began to hear the finish line announcer, I ran like hell.

Every muscle fiber in my legs were screaming in pain. Most of the last mile my eyes were closed. I kept them clinched shut and told myself it was just the final lap of my last mile repeat on a track day. And it ended up being my fastest mile of the day.

When I rounded the last corner, out of the dark and into the bright lights, the clamor of cow bells and the screaming crowd lining the finish chute drowned out the noise from my quads, and I ran.

Just before I hit the timing mat, I opened my eyes and looked up at the clock.

10:59:07

Some guy grabbed me, wrapped a mylar blanket around my shoulders and a voice boomed over the loudspeakers…

“CHRISTOPHER SEGLER……...YOU... ARE…...AN IROMAN!!!!!!!!!!!!!!!”

What a way to end the day!